Venous thromboembolism in women with ovarian cancer undergoing neoadjuvant chemotherapy prior to cytoreductive surgery: A retrospective study.

INTRODUCTION: Ovarian cancer is associated with a venous thromboembolism risk of at least 7.2% by 2 years from diagnosis, and although patients undergoing surgery benefit from routine thromboprophylaxis, those undergoing neoadjuvant chemotherapy do not. This study aims to determine the venous thromboembolism incidence in patients with ovarian cancer undergoing neoadjuvant chemotherapy, and explore whether any subset is at higher risk, in order to evaluate whether thromboprophylaxis is justified in some or all of these patients. MATERIAL AND METHODS: This was a retrospective review of all women undergoing neoadjuvant chemotherapy for FIGO radiological stages III and IV primary ovarian, fallopian tube, and primary peritoneal cancer, between 2000 and 2015, in a London tertiary cancer center. The primary outcome was venous thromboembolism rate among women undergoing neoadjuvant chemotherapy. The secondary outcomes were patient or treatment factors associated with venous thromboembolism risk, including age, body mass index, smoking status, performance status, and tumor stage. RESULTS: We identified 278 eligible women from the ovarian cancer database. Fifty-eight women (20.9%) developed venous thromboembolism between initial presentation and the immediate postoperative period, of which 45 (77.6%) developed a pulmonary embolism. In all, 15.1% of women developed venous thromboembolism from the start of neoadjuvant chemotherapy. Age, body mass index, smoking, or other comorbidities were not significantly associated with venous thromboembolism risk. One woman died from massive pulmonary embolism, 27 women underwent inferior vena cava filter insertion, and 10 had surgery delayed. CONCLUSIONS: This study demonstrates an unacceptably high rate of avoidable venous thromboembolism including pulmonary embolism in these women, which complicates and delays treatment. Thromboprophylaxis during neoadjuvant chemotherapy should now be assessed prospectively.

Laparoscopic wrap round mesh sacrohysteropexy for the management of apical prolapse.

INTRODUCTION AND HYPOTHESIS: Interest in uterine-conserving surgery for apical prolapse is growing. Laparoscopic sacrohysteropexy is one of the conservative surgical options, although different surgical approaches have been described. We report medium-term outcome data using a bifurcated mesh implant, employing 'wrap round' uterine attachment. METHODS: All procedures undertaken at our unit were reviewed. Study inclusion was contingent on the collection of baseline and 3-month anatomical and symptomatic outcome data. Medium-term follow-up data were collected by telephone review. Anatomical outcome was reported using the Pelvic Organ Prolapse Quantification scale. Symptom prevalence and treatment response were assessed using validated instruments including the Patient Global Impression of Improvement scale (PGI-I), and the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ-UI) and Vaginal Symptoms (ICIQ-VS) questionnaires. Patient satisfaction was reported using Kaplan-Meier survival analysis. RESULTS: Data were available for 110 patients. Of 80 patients providing PGI-I data at 3 months, 75 (94 %) described their prolapse symptoms as 'much better' or 'very much better'. Anatomical success in the apical compartment was 98 %. ICIQ-UI and ICIQ-VS responses demonstrated significant improvement. Despite a concurrent vaginal repair in only 11 % of patients, satisfaction at a mean follow-up of 2.6 years was 96 %. Repeat surgery for vaginal wall prolapse was required in only 5 % of patients. No safety concerns or graft complications were recorded. CONCLUSIONS: This surgical variant of laparoscopic sacrohysteropexy is safe and highly effective. These data also cast doubt on the need for correction of modest vaginal wall prolapse at the time of surgery, and imply that apical prolapse may play a dominant role in the generation of symptoms.

Perineal lipoma with accessory labioscrotal fold and penis-like phallus in a female infant with unilateral renal agenesis.

We present a case of a female 46,XX infant with a perineal lipoma within an accessory labioscrotal fold containing a penis-like phallus, associated with contralateral renal agenesis and complete absence of Müllerian/paramesonephric structures. To our knowledge, this is the first report of perineal lipoma and accessory labioscrotal fold associated with urogenital abnormalities in a female. The case also has an exceptional penis-like phallus in the absence of Y chromosome material or evidence of virilization.